An endoscopic ultrasound is inserted to show the location of the cyst, select an appropriate puncture point, and display adjacent vascular structures with a color flow map.
The shape is ideal. This position and image performance are exactly what Professor Yang imagined, with almost no deviation.
He knows that his level is constantly growing. Every time I come into contact with and learn a new technique, there will be such an exciting process. This feeling is also Professor Yang's favorite.
The growth and joy are really intoxicating.
The puncture needle was retracted into the outer sheath and inserted into the endoscopic ultrasonic tube. Professor Yang then sent the puncture needle into the stomach and carefully extended the needle tip to avoid making a hole in the stomach wall before the operation could be performed.
Although the hole was a bit shocking and the stomach wall was recovering well, Professor Yang still paid careful attention to every step of the operation.
He then identified the position of the needle tip on the ultrasound image and inserted the needle into the cyst cavity under the guidance of the ultrasound image.
When you feel a clear sense of loss, it indicates that the puncture needle has entered the cyst. Professor Yang felt reassured. This was because the bag wall was not causing trouble for him. If puncture is difficult, the puncture needle must be connected to a high-frequency electric cutter to pass pure electric cutter current. If that were the case, it would be very troublesome.
I'm feeling lucky today. During the preoperative evaluation, Professor Yang had the idea that the puncture of the cyst wall would not go smoothly.
Everything went well, and he almost hummed a light song.
The 19G puncture needle successfully punctured the cyst wall and inserted a 0.035-inch guidewire. After using 4mm and 6mm diameter dilators to expand the puncture tract, a 24mm dual-lumen juxtaposed metal stent was successfully placed under guidewire guidance.
The operation was basically over here. Professor Yang carefully observed the pancreatic pseudocyst with a B-ultrasound probe. It was found to begin to shrink, which meant that the fluid trapped inside the cyst was being directed into the stomach and subsequently into the intestines.
very smooth! The corners of Professor Yang's mouth raised slightly under the mask.
The patient who underwent this surgery had almost the largest pancreatic pseudocyst he had ever seen or performed. In the case of laparoscopic surgery, it is difficult to ensure that complications will not occur.
However, there are not many complications with endoscopic ultrasound-guided drainage of pancreatic pseudocyst. It is just an internal drainage. What complications can there be? Professor Yang believes that the biggest risk lies in the puncture step. God knows whether puncture bleeding will occur if there are no blood vessels on the B-ultrasound.
That would be fucked up if that were the case.
People who engage in medical treatment are very cautious, and Professor Yang is a more moderate person.
When I first started working, pancreatic pseudocyst was a serious disease. The surgical grade was very high and the postoperative risks were extremely high. After the introduction of laparoscopy, the surgical procedure and postoperative complications have been reduced accordingly.
But now, surgery is like "playing". Professor Yang is a doctor who has personally experienced these stages, so his feelings are extremely profound.
"Professor Yang, the operation is over now." the anesthesiologist asked with a smile.
"Well, it's almost done." Professor Yang was not in a hurry. After observing for a few more minutes and confirming that the pancreatic pseudocyst had become smaller, he said with a smile: "It's done."
"Professor Yang, can pseudocysts be treated this way in the future?" the anesthesiologist asked.
"How could it be!" Professor Yang finished the operation and his mood became high. He said casually: "The pseudocyst is close to the wall of the gastrointestinal tract, and there is no obstruction by large blood vessels. The part of the digestive tract is compressed and bulged by the cyst, and the mucosa has The color change is obviously more ideal. This is a necessary condition now. I want to use minimally invasive treatment in all situations, and I am at the level of Boss Zheng. Me? I don’t want to do it in the next life. "
"You are too modest." The anesthesiologist smiled.
"It's important for people to be self-aware." Professor Yang said seriously: "This is not modesty, it is the truth. Boss Zheng is so awesome, I don't want to think about it."
"Hey." The anesthesiologist didn't know what he was thinking and chuckled.
"If you don't believe me, let's just talk about this operation. Whether the stent is blocked after the operation needs to be checked by interventional angiography. I am lucky, and the patient screening is very good. If it is carried out in large quantities, I will definitely trouble Boss Zheng sooner or later. "Professor Yang said.
Professor Yang has made a careful analysis of the indications for pancreatic pseudocyst drainage under endoscopic ultrasound guidance and how to treat the child after the accident. When I was in Japan, I also consulted my mentors.
There are reasons why surgeries go smoothly and seem simple and easy.
No success is achieved inexplicably, Professor Yang firmly believes in this. He saw that the cyst had shrunk and began to withdraw the guidewire.
While pulling out the guide wire, he said kindly: "Don't tell others what you just said, Boss Zheng..."
Having said this, Professor Yang was startled.
The guide wire...can't even be pulled! Normally, you should hold the guidewire in your hand at this time and take it out smoothly.
I can't pull it, what the hell is this!
Where is it stuck? No, the guide wire is so thin and slippery, how could it get stuck
What complication is this? What kind of unexpected situation is this? Professor Yang was stunned for a moment.
I was fully prepared, but I didn't expect that something unexpected happened when the operation was "over".
Professor Yang panicked.
He immediately used B-ultrasound to take a look, but B-ultrasound had its own advantages and disadvantages. At this time, it was useless to use P.
"Professor Yang, what are you going to do?" the anesthesiologist asked strangely.
"..." Professor Yang felt like crying.
You really can't show off at all. Just after you showed off, something happened immediately.
The most important thing is that I didn't show off, so the anesthesiologist praised me a few times, and I spoke to him in a serious and thoughtful manner.
When the anesthesiologist realized something was wrong, he stopped what he was doing and did not push the medicine to the patient. But when the patient wakes up, something goes wrong during the operation, and there is no way to explain it.
He looked into Professor Yang's eyes and waited for him to explain the situation.
"Okay... I really think the guide wire is stuck."
The anesthesiologist suddenly smiled.
"Professor Yang, don't kid me." the anesthesiologist said, "the guide wire is nothing else. If you said the stent was stuck, I would still believe it. The guide wire is stuck? How is that possible?"
Professor Yang cursed in his heart, I don’t believe MMP at all.
He tried again, but still couldn't pull the guide wire.
"It's really stuck. I'm not kidding." Professor Yang calmed down and said immediately: "Is there anyone in the hybrid operating room?"
"There is an orthopedic surgery, and there is an empty operating table. Please wait a moment, and I will take a look." After the anesthesiologist finished speaking, he ran out quickly.
Professor Yang stood on the operating table, wanting to cry but without tears.
He was also confused about what happened. Are you not careful enough? Is there any operational error? yes…
neither!
At this time, he had no idea what was happening.
…
…
Note: Quoted from the Journal of the British Society of Gastroenterology, Gastrointestinal Endoscopy, September 27, 2015.